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1040X
                                                                                   Department of the Treasury—Internal Revenue Service
Form                                                                                                                                                                             OMB No. 1545-0074
                                                                 Amended U.S. Individual Income Tax Return
                                                                                                  See separate instructions.
(Rev. February 2009)
This return is for calendar year                                                         , or fiscal year ended                                                 ,                     .
                             Your first name and initial                                                       Last name                                                 Your social security number
    Please print or type




                                                                                                                                                                         Spouse’s social security number
                             If a joint return, spouse’s first name and initial                                Last name


                             Home address (no. and street) or P.O. box if mail is not delivered to your home                                         Apt. no.            Phone number
                                                                                                                                                                         (                )
                             City, town or post office, state, and ZIP code. If you have a foreign address, see page 4 of the instructions.



A If the address shown above is different from that shown on your last return filed with the IRS, would you like us to change it
  in our records?                                                                                                Yes       No
B Filing status. Be sure to complete this line. Note. You cannot change from joint to separate returns after the due date.
                           On original return           Single           Married filing jointly             Married filing separately                Head of household                    Qualifying widow(er)
                           On this return             Single          Married filing jointly      Married filing separately                          Head of household*                   Qualifying widow(er)
                           * If the qualifying person is a child but not your dependent, see page 4 of the instructions.
                                                                                                                                                         B. Net change—
                                                                                                                                 A. Original amount or
                                    Use Part II on the back to explain any changes                                                                      amount of increase                    C. Correct
                                                                                                                                 as previously adjusted
                                                                                                                                                          or (decrease)—                       amount
                                                                                                                                      (see page 4)
                                                                                                                                                         explain in Part II
                                      Income and Deductions (see instructions)
                                                                                                                            1
                                 Adjusted gross income (see page 4)
                             1
                                                                                                                            2
                                 Itemized deductions or standard deduction (see page 4)
                             2
                                                                                                                            3
                                 Subtract line 2 from line 1
                             3
                             4   Exemptions. If changing, fill in Parts I and II on the back
                                                                                                                            4
                                 (see page 5)
                                 Taxable income. Subtract line 4 from line 3
                             5                                                                                              5
                                                                                                                            6
 Tax Liability




                                 Tax (see page 5). Method used in col. C
                            6
                                                                                                                            7
                                 Credits (see page 6)
                            7
                                                                                                                           8
                                 Subtract line 7 from line 6. Enter the result but not less than zero
                            8
                                                                                                                           9
                            9    Other taxes (see page 6)
                                 Total tax. Add lines 8 and 9
                           10                                                                                              10
                                 Federal income tax withheld and excess social security and
                           11
                                                                                                     11
                                 tier 1 RRTA tax withheld. If changing, see page 6
                           12    Estimated tax payments, including amount applied from prior
Payments




                                                                                                     12
                                 year’s return
                                                                                                     13
                           13    Earned income credit (EIC)
                                                                                                     14
                           14    Additional child tax credit from Form 8812
                           15    Credits: Recovery rebate; federal telephone excise tax; or from
                                                                                                     15
                                 Forms 2439, 4136, 5405, 8885, or 8801 (refundable credit only)
                                                                                                                                                                                 16
                                 Amount paid with request for extension of time to file (see page 6)
                           16
                                                                                                                                                                                 17
                           17    Amount of tax paid with original return plus additional tax paid after it was filed
                           18    Total payments. Add lines 11 through 17 in column C                                                                                             18
                                                                         Refund or Amount You Owe
                                                                  Note. Allow 8-12 weeks to process Form 1040X.
                                                                                                                                                                                 19
                                 Overpayment, if any, as shown on original return or as previously adjusted by the IRS
                           19
                                                                                                                                                                                 20
                                 Subtract line 19 from line 18 (see page 6)
                           20
                                                                                                                                                                                 21
                                 Amount you owe. If line 10, column C, is more than line 20, enter the difference and see page 6
                           21
                                                                                                                                                                                 22
                                 If line 10, column C, is less than line 20, enter the difference
                           22
                                                                                                                                                                                 23
                           23    Amount of line 22 you want refunded to you
                           24    Amount of line 22 you want applied to your                 estimated tax       24
Sign                                  Under penalties of perjury, I declare that I have filed an original return and that I have examined this amended return, including accompanying schedules
                                      and statements, and to the best of my knowledge and belief, this amended return is true, correct, and complete. Declaration of preparer (other than
Here                                  taxpayer) is based on all information of which the preparer has any knowledge.
Joint return?
See page 4.
Keep a copy for
                                           Your signature                                               Date                     Spouse’s signature. If a joint return, both must sign.          Date
your records.
                                                                                                                          Date                                               Preparer’s SSN or PTIN
                                      Preparer’s                                                                                                 Check if
Paid                                  signature                                                                                                  self-employed
Preparer’s                            Firm’s name (or                                                                                                  EIN
Use Only                              yours if self-employed),
                                      address, and ZIP code                                                                                            Phone no. (           )
                                                                                                                                                                                      1040X
For Paperwork Reduction Act Notice, see page 8 of instructions.                                                            Cat. No. 11360L                                   Form                (Rev. 2-2009)
2
Form 1040X (Rev. 2-2009)                                                                                                                               Page
Part I      Exemptions. See Form 1040 or 1040A instructions.                                      A. Original
                                                                                                  number of
      Complete this part only if you are:                                                                                                     C. Correct
                                                                                                  exemptions
      ● Increasing or decreasing the number of exemptions claimed on line 6d                                          B. Net change           number of
                                                                                                reported or as
                                                                                                                                              exemptions
      of the return you are amending, or                                                           previously
                                                                                                    adjusted
      ● Increasing or decreasing the exemption amount for housing individuals
      displaced by Hurricane Katrina or for housing Midwestern displaced individuals.
                                                                                      25
      Yourself and spouse
25
      Caution. If someone can claim you as a dependent, you cannot claim an
      exemption for yourself.
                                                                                      26
      Your dependent children who lived with you
26
27    Your dependent children who did not live with you due to divorce or
                                                                                      27
      separation
                                                                                      28
      Other dependents
28
                                                                                      29
29    Total number of exemptions. Add lines 25 through 28
      Multiply the number of exemptions claimed on line 29 by the amount listed
30
      below for the tax year you are amending. Enter the result here.
                                                   But see the instructions for
              Tax          Exemption               line 4 on page 5 if the
              year          amount                 amount on line 1 is over:
              2008            $3,500                          $119,975
              2007             3,400                           117,300
              2006             3,300                           112,875
              2005             3,200                           109,475
                                                                                      30
      If you are claiming an exemption amount for housing individuals displaced by
31
      Hurricane Katrina, enter the amount from Form 8914, line 2 for 2005 or line 6
      for 2006. If you are claiming an exemption amount for housing Midwestern
      displaced individuals, enter the amount from the 2008 Form 8914, line 2. (See
      instructions for line 4). Otherwise enter -0-                                   31
32                                                                                    32
      Add lines 30 and 31. Enter the result here and on line 4
33    Dependents (children and other) not claimed on original (or adjusted) return:                                                No. of children
                                                                                                                                   on 33 who:

                                                                                       (c) Dependent’s (d)        if qualifying    ● lived with
                                                             (b) Dependent’s social
                                                                                      relationship to you child for child tax
                                                                 security number                                                   you
                                                                                                          credit (see page 7)
      (a) First name                   Last name
                                                                                                                                   ● did not live
                                                                                                                                   with you due to
                                                                                                                                   divorce or
                                                                                                                                   separation (see
                                                                                                                                   page 7)

                                                                                                                                   Dependents
                                                                                                                                   on 33 not
                                                                                                                                   entered above
Part II     Explanation of Changes
            Enter the line number from the front of the form for each item you are changing and give the reason for each change.
            Attach only the supporting forms and schedules for the items changed. If you do not attach the required information,
            your Form 1040X may be returned. Be sure to include your name and social security number on any attachments.
If the change relates to a net operating loss carryback or a general business credit carryback, attach the schedule or form
that shows the year in which the loss or credit occurred. See pages 2 and 3 of the instructions. Also, check here




Part III Presidential Election Campaign Fund. Checking below will not increase your tax or reduce your refund.
If you did not previously want $3 to go to the fund but now want to, check here
If a joint return and your spouse did not previously want $3 to go to the fund but now wants to, check here
                                                                                                                                         1040X
                                                                                                                                  Form            (Rev. 2-2009)

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Form 1040X*-Amended Individual Income Tax Return

  • 1. 1040X Department of the Treasury—Internal Revenue Service Form OMB No. 1545-0074 Amended U.S. Individual Income Tax Return See separate instructions. (Rev. February 2009) This return is for calendar year , or fiscal year ended , . Your first name and initial Last name Your social security number Please print or type Spouse’s social security number If a joint return, spouse’s first name and initial Last name Home address (no. and street) or P.O. box if mail is not delivered to your home Apt. no. Phone number ( ) City, town or post office, state, and ZIP code. If you have a foreign address, see page 4 of the instructions. A If the address shown above is different from that shown on your last return filed with the IRS, would you like us to change it in our records? Yes No B Filing status. Be sure to complete this line. Note. You cannot change from joint to separate returns after the due date. On original return Single Married filing jointly Married filing separately Head of household Qualifying widow(er) On this return Single Married filing jointly Married filing separately Head of household* Qualifying widow(er) * If the qualifying person is a child but not your dependent, see page 4 of the instructions. B. Net change— A. Original amount or Use Part II on the back to explain any changes amount of increase C. Correct as previously adjusted or (decrease)— amount (see page 4) explain in Part II Income and Deductions (see instructions) 1 Adjusted gross income (see page 4) 1 2 Itemized deductions or standard deduction (see page 4) 2 3 Subtract line 2 from line 1 3 4 Exemptions. If changing, fill in Parts I and II on the back 4 (see page 5) Taxable income. Subtract line 4 from line 3 5 5 6 Tax Liability Tax (see page 5). Method used in col. C 6 7 Credits (see page 6) 7 8 Subtract line 7 from line 6. Enter the result but not less than zero 8 9 9 Other taxes (see page 6) Total tax. Add lines 8 and 9 10 10 Federal income tax withheld and excess social security and 11 11 tier 1 RRTA tax withheld. If changing, see page 6 12 Estimated tax payments, including amount applied from prior Payments 12 year’s return 13 13 Earned income credit (EIC) 14 14 Additional child tax credit from Form 8812 15 Credits: Recovery rebate; federal telephone excise tax; or from 15 Forms 2439, 4136, 5405, 8885, or 8801 (refundable credit only) 16 Amount paid with request for extension of time to file (see page 6) 16 17 17 Amount of tax paid with original return plus additional tax paid after it was filed 18 Total payments. Add lines 11 through 17 in column C 18 Refund or Amount You Owe Note. Allow 8-12 weeks to process Form 1040X. 19 Overpayment, if any, as shown on original return or as previously adjusted by the IRS 19 20 Subtract line 19 from line 18 (see page 6) 20 21 Amount you owe. If line 10, column C, is more than line 20, enter the difference and see page 6 21 22 If line 10, column C, is less than line 20, enter the difference 22 23 23 Amount of line 22 you want refunded to you 24 Amount of line 22 you want applied to your estimated tax 24 Sign Under penalties of perjury, I declare that I have filed an original return and that I have examined this amended return, including accompanying schedules and statements, and to the best of my knowledge and belief, this amended return is true, correct, and complete. Declaration of preparer (other than Here taxpayer) is based on all information of which the preparer has any knowledge. Joint return? See page 4. Keep a copy for Your signature Date Spouse’s signature. If a joint return, both must sign. Date your records. Date Preparer’s SSN or PTIN Preparer’s Check if Paid signature self-employed Preparer’s Firm’s name (or EIN Use Only yours if self-employed), address, and ZIP code Phone no. ( ) 1040X For Paperwork Reduction Act Notice, see page 8 of instructions. Cat. No. 11360L Form (Rev. 2-2009)
  • 2. 2 Form 1040X (Rev. 2-2009) Page Part I Exemptions. See Form 1040 or 1040A instructions. A. Original number of Complete this part only if you are: C. Correct exemptions ● Increasing or decreasing the number of exemptions claimed on line 6d B. Net change number of reported or as exemptions of the return you are amending, or previously adjusted ● Increasing or decreasing the exemption amount for housing individuals displaced by Hurricane Katrina or for housing Midwestern displaced individuals. 25 Yourself and spouse 25 Caution. If someone can claim you as a dependent, you cannot claim an exemption for yourself. 26 Your dependent children who lived with you 26 27 Your dependent children who did not live with you due to divorce or 27 separation 28 Other dependents 28 29 29 Total number of exemptions. Add lines 25 through 28 Multiply the number of exemptions claimed on line 29 by the amount listed 30 below for the tax year you are amending. Enter the result here. But see the instructions for Tax Exemption line 4 on page 5 if the year amount amount on line 1 is over: 2008 $3,500 $119,975 2007 3,400 117,300 2006 3,300 112,875 2005 3,200 109,475 30 If you are claiming an exemption amount for housing individuals displaced by 31 Hurricane Katrina, enter the amount from Form 8914, line 2 for 2005 or line 6 for 2006. If you are claiming an exemption amount for housing Midwestern displaced individuals, enter the amount from the 2008 Form 8914, line 2. (See instructions for line 4). Otherwise enter -0- 31 32 32 Add lines 30 and 31. Enter the result here and on line 4 33 Dependents (children and other) not claimed on original (or adjusted) return: No. of children on 33 who: (c) Dependent’s (d) if qualifying ● lived with (b) Dependent’s social relationship to you child for child tax security number you credit (see page 7) (a) First name Last name ● did not live with you due to divorce or separation (see page 7) Dependents on 33 not entered above Part II Explanation of Changes Enter the line number from the front of the form for each item you are changing and give the reason for each change. Attach only the supporting forms and schedules for the items changed. If you do not attach the required information, your Form 1040X may be returned. Be sure to include your name and social security number on any attachments. If the change relates to a net operating loss carryback or a general business credit carryback, attach the schedule or form that shows the year in which the loss or credit occurred. See pages 2 and 3 of the instructions. Also, check here Part III Presidential Election Campaign Fund. Checking below will not increase your tax or reduce your refund. If you did not previously want $3 to go to the fund but now want to, check here If a joint return and your spouse did not previously want $3 to go to the fund but now wants to, check here 1040X Form (Rev. 2-2009)